SQuIRE 2.0

The Standards for Quality Improvement Reporting Excellence (SQuIRE) guidelines are the international writing guidelines for quality improvement publications. The guidelines provide a framework for reporting new knowledge about how to improve healthcare. They are intended for reports that describe system level work to improve the quality, safety, and value of healthcare, using a range of methods to establish the association between observed outcomes and intervention(s). Following the publication the inaugural SQuIRE guidelines (SQuIRE 1.0) in 2008, the guidelines were revised and published in 2015 as SQuIRE 2.0. These guidelines aim to reflect the dynamic nature and the wide variety of approaches used in healthcare improvement efforts. 

Publication:

Greg Ogrinc, Louise Davies, Daisy Goodman, Paul Batalden, Frank Davidoff3, David Stevens SQuIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process

 

Click here to download the SQuIRE 2.0 checklist

 

Text Section and Item Name Section or Item Description
Notes to Authors
  • The SQuIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare.
  • The SQuIRE guidelines are intended for reports that describe system level work to improve the quality, safety and value of healthcare, and used methods to establish that observed outcomes were due to intervention(s).
  • A range of approaches exists for improving healthcare.  SQuIRE may be adapted for reporting any of these.
  • Authors should consider every SQuIRE item, but it may be inappropriate or unnecessary to include every SQuIRE element in a particular manuscript.
  • The SQuIRE glossary https://qualitysafety.bmj.com/content/early/2015/09/10/bmjqs-2015-004411.full contains definitions of many of the keywords in SQuIRE.
  • The Explanation and Elaboration document provides specific examples of well written SQuIRE items, and an in-depth explanation of each item.
  • Please cite SQuIRE when it is used to write a manuscript.
Title and Abstract  
1. Title Indicate that the manuscript concerns an initiative to improve healthcare (broadly defined to include the quality, safety, effectiveness, patient-centredness, timeliness, cost, efficiency and equity of healthcare).
2. Abstract

a. Provide adequate information to aid in searching and indexing

b. Summarize all key information from various sections of the text using the abstract format of the intended publication or a structured summary such as background, local problem, methods, interventions, results, conclusions.
Introduction Why did you start?
3. Problem description Nature and significance of the local problem.
4. Available knowledge

Summary of what is currently known about the problem, including relevant previous studies.
5. Rationale Informal or formal frameworks, models, concepts, and/or theories used to explain the problem, any reasons or assumptions that were used to develop the intervention(s), and reasons why the intervention(s) was expected to work.
6. Specific aims

Purpose of the project and of this report.
Methods What did you do?
7. Context Contextual elements considered important at the outset of introducing the intervention(s).
8. Intervention(s)

a. Description of the intervention(s) in sufficient detail that others could reproduce it.

b. Specifics of the team involved in the work.
9. Study of the intervention(s)

a. Approach chosen for assessing the impact of the intervention(s).

b. Approach used to establish whether the observed outcomes were due to the intervention(s).
10. Measures

a. Measures chosen for studying processes and outcomes of the intervention(s), including rationale for choosing them, their operational definition, and their validity and reliability.

b. Description of the approach to the ongoing assessment of contextual elements that contributed to the success, failure, efficiency and cost.

c. Methods employed for assessing completeness and accuracy of data.
11. Analysis

a. Qualitative and quantitative methods used to draw inferences from the data.

b. Methods for understanding variation within the data, including the effects of time as a variable.
12. Ethical considerations Ethical aspects of implementing and studying the intervention(s) and how they were addressed, including but not limited to, formal ethics review and potential conflict(s) of interest.
Results What did you find?
13. Results

a. Initial steps of the intervention(s) and their evolution over time (eg. timeline diagram, flow chart or table), including modifications made to the intervention(s) during the project.

b. Details of the process measure and outcome.

c. Contextual elements that interacted with the intervention(s).

d. Observed associations between outcomes, intervention(s) and relevant contextual elements.

e. Unintended consequences such as unexpected benefits, problems, failures or costs associated with the intervention(s).

f. Details about missing data.
Discussion What does it mean?
14. Summary

a. Key findings, including relevance to the rationale and specific aims.

b. Particular strengths of the project.
15. Interpretation

a. Nature of the association between the intervention(s) and the outcomes.

b. Comparison of results with findings from other publications.

c. Impact of the project on people and systems.

d. Reasons for any differences between observed and anticipated outcomes, including the influence of context.

e. Cost and strategic trade-offs, including opportunity costs.
16. Limitations

a. Limits of the generalizability of the work.

b. Factors that might have limited internal validity such as confounding, bias or imprecision in the design, methods, measurements or analysis.

c. Efforts made to minimize and adjust for limitations.
17. Conclusions

a. Usefulness of the work.

b. Sustainability.

c. Potential for spread to other contexts.

d. Implications for practice and for further study in the field.

e. Suggested next steps.
Other Information  
18. Funding Sources of funding that supported this work. Role, if any, of the funding organization in the design, implementation interpretation and reporting.